Provider Demographics
NPI:1275982373
Name:CRISP & ASSOCIATES III, LLC
Entity Type:Organization
Organization Name:CRISP & ASSOCIATES III, LLC
Other - Org Name:CHRISTIANS MEDICAL EQUIPMENT & SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:CRISP
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:678-873-3192
Mailing Address - Street 1:1057 MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-1482
Mailing Address - Country:US
Mailing Address - Phone:404-362-6901
Mailing Address - Fax:404-362-6904
Practice Address - Street 1:1057 MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-1482
Practice Address - Country:US
Practice Address - Phone:404-362-6901
Practice Address - Fax:404-362-6904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies